This transcript is in relation to an interview “Listen In With KNN” host Kelsey Nicole Nelson did with Dr. Mohamad Allaf for Prostate Cancer Awareness Month.
Kelsey Nicole Nelson – 01:48
“Welcome to another exciting livestream edition of Listen In With KNN presented by Fox Sports Radio, 96.9 FM and 1340 AM. I’m of course, your host, Kelsey Nicole Nelson. Thanks, as always for joining me, I am super excited for today’s show. We’re gonna be talking Prostate Cancer Awareness Month, which it’s September. Obviously, we want to make sure that we’re staying healthy and we want to just make sure we’re doing our best live nice, long lives because that’s what we all want, of course, right? Just to live another day and of course, just live healthy. That’s what we all want. So I’m excited. As you all know, prostate cancer is near and dear to my heart. It’s been a problem in my family. It’s something that I have committed pretty much my whole September to because I want to spread the awareness because knowledge is power. And of course if you have knowledge, I believe in sharing it with others. I’m so excited to welcome on today’s guest. It is his first time on the show and I’m bringing out the big guns I decided to bring in Dr. Mohamad Allaf. He is the Executive Vice Chairman of the Department of Urology and a professor of Neurology with Johns Hopkins Medicine. I am super excited to have him on. He’s going to tell us all that we need to know and I hope you all stay tuned because this is a very special message. So without further ado, I’m going to welcome him on the show. Dr. Allaf, how are you today?”
Dr. Mohamad Allaf – 02:55
“Kelsey, how are you? It’s a pleasure to be on.”
Kelsey Nicole Nelson – 02:57
“I’m so excited. It’s my honor and pleasure. Your first time on the show, but definitely not the last time because we definitely want them. Now, of course, all the great stuff that you’re doing but I like to do a wellness check with my guests first. How are you feeling? How are you doing? Obviously COVID-19 has been a year like none other in 2020. So how are you and your family holding?”
Dr. Mohamad Allaf – 03:14
“We are thankfully doing well. We had a baby recently. So during a pandemic, so that was a blessing for us. But it’s been a tough year I think for for everybody, including our families and you know, for me our patients. But we’re all strong and we’re moving forward. And it’s a beautiful day outside. So I’m feeling good today.”
Kelsey Nicole Nelson – 03:38
“Yes, nice loving, we can never complain about the DMV Baltimore area. Sometimes you don’t know but likely will be with good weather. Do we get the baby name that is so exciting. Congratulations.”
Dr. Mohamad Allaf – 03:49
“Yeah, the baby’s Jude. He’s about a month old now. So yeah, it’s very exciting.”
Kelsey Nicole Nelson – 03:54
“So exciting. Again, just congratulations on that and then let’s get into it. It’s September Prostate Cancer Awareness month and we want to make sure people know about what’s going on how to stay healthy off course because we want people to live very, very, very long lives. So first, to kick it off. I think the most important question is, who’s at risk? Right because we hear prostate cancer, I think many say, you know, should I be worried, you know, is that going to affect me? So who would you say is at the highest risk for getting prostate cancer within their lifetime?”
Dr. Mohamad Allaf – 04:20
“Yeah, unfortunately, Kelsey, you know, your family’s been been struck with prostate cancer and many families in the United States and around the globe will be unfortunately dealing with prostate cancer. It is the most common cancer diagnosed in men and it is amongst the largest in terms of killers of men in cancer diagnosis. It’s a disease of aging men, so certainly it’s men. It’s older men as we age, we’re at an increased risk of having prostate cancer. Men who have a family history in particular, a first degree relative or multiple relatives is going to be at a higher risk of harboring prostate cancer. Men who are African Americans, unfortunately, are also an increased risk relative to Caucasian men in having prostate cancer. And when it afflicts African American men, unfortunately, it usually is diagnosed a little further along and is a little bit more aggressive. And there are a lot of theories as to why that may be related to maybe disparities in care that we as a society have to do better about. But there also may be some biological explanations as well. So older men, men with a family history, and men of African heritage are going to be at increased risk.”
Kelsey Nicole Nelson – 05:44
“I appreciate you touching on that because we know in the African American community, it’s been, you know, something that we’re trying to get more awareness about, because I’ve always been curious to know why does it affect black men the most. I really appreciate you touching on that just seems like it’s biological factors that unfortunately, we have no control over. But that’s why it’s more important that you keep track of your health and checking yourself to make sure that you’re healthy. And while we’re on that, obviously, you heard about the risk factors. So now let’s talk about who should be getting checked and when you should get checked. What’s that process like for all the men out there?”
Dr. Mohamad Allaf – 06:13
“Very good question and luckily, unlike any other cancer or most cancers, we actually have a screening test that we could send for prostate cancer, and it’s a blood test called the PSA, the prostate specific antigen. Now, it is a number that you’ll get back from your doctor, the recommendation is to have a discussion with your doctor, between ages of 55 to 69. It would be shared decision making with your physician as to you know, when you should get the PSA. But the recommendation would be for that age group, along with a digital rectal examination. Now the PSA, if it’s abnormal, it doesn’t necessarily mean you have prostate cancer. It’s sort of just like throwing a red flag saying there’s something going on here, guys, and that we need to work this out a little bit more. Unfortunately, if prostate cancer is diagnosed early, it is virtually curable in most circumstances, I mean, very, very high cure rate, as long as it’s picked up early. It is when it’s picked up late, when we get into trouble. So it is very, very important to have those discussions with your physicians. And to and to get checked because it’s a simple blood test and an exam that you would do in the office that can give you your specific risk of having prostate cancer.”
Kelsey Nicole Nelson – 07:34
“I appreciate you touching on that because of course, it’s like how was it diagnosed, but I’ll be honest with you, doctor, a lot, many men that I talked to every time I do this, they say Kelsey, I don’t know anyone near my rectum mentioned the rectal exam. So I’m just gonna be real with you. I mean, how do you put people at ease for that type of thing?”
Dr. Mohamad Allaf – 07:50
“Yeah, I mean, it’s very hard. I think a light hearted physician can make the process a lot easier for you. But as a guy myself, I certainly don’t look forward to those exams. I usually tell men, it’s not my favorite part of the day, and neither is it going to be yours but we sort of have to do it. I’ll tell you though, there are there are alternatives. You know, for example, imaging is getting better. So scans like MRI in particular, making a big entrance into the arena of prostate cancer screening. And while a rectal exam is much simpler, is less expensive can be done in the office. But for the guy who’s really sort of apprehensive about it, and if there’s a suspicion, a family history, or the PSA is a little bit high, then the next step could be an MRI. And we’re lucky today that we have an emerging array of other tests that can also help us risk stratify. So somebody has a PSA, it’s high, but not very high. Do you proceed with the biopsy? Because that would be the next step is to get a piece of the prostate to say yay or nay we have prostate cancer. But before we go there today, we actually have an embarrassment of riches. There’s, you know, three or four tests, urine tests and other blood tests and the MRI to help tell us should we really go for that biopsy? Or are we okay with this elevated PSA? Could it just be enlargement of the prostate or inflammation which men get as we also age and out there cycling and doing all the things that can irritate that organ?”
Kelsey Nicole Nelson – 09:25
“I appreciate you touching on that and then I just wanna make sure people understand what the PSA blood test is just in your layman terms, because I think it’s still a new term, probably many. How would you describe the PSA blood test?”
Dr. Mohamad Allaf – 09:36
“So it’s called PSA because it stands for Prostate-Specific Antigen, which is, so it’s prostate specific, not prostate cancer specific, but when there is cancer in the prostate, the idea is that the prostate makes this PSA and the architecture of the prostate gets disrupted, and that PSA is now spilled into the bloodstream and it’s picked up as a red flag for something going on in the prostate. When the PSA is elevated, generically speaking, about one in four men who have an elevated PSA, say, between four and 10 are going to have prostate cancer, but three out of four are not going to have prostate cancer, and what do they have; enlargement that can do the same thing, spill some PSA and inflammation. Those would be the two other, you know, there are some, you know, trauma to the prostate can do it. You know, we want you to abstain from sexual activity a day or two before you come in to get the test because any kind of activity down there can cause the PSA to come up a little bit. And certainly, if it’s elevated, the important thing for the audience is we need to recheck it before we panic because one isolated test could be completely a fluctuation that’s not real. And so confirmation of that PSA, and then moving on with that, coupled with that discussion is the way to go.”
Kelsey Nicole Nelson – 10:57
“Okay well, that’s great to know because I think the other question many ask the doctor, you know, I have no symptoms, you know, what do you mean if you get diagnosed with prostate cancer? So for those out there, is there anything that they can do especially at home in this Covid environment of person who are social distancing and not wanting to go out as much? Is there anything that they can start to check for before they go into the doctor’s office? Because after a lot, I do believe some people are kind of nervous now, more than ever to go into a doctor appointment.”
Dr. Mohamad Allaf – 11:22
“Yeah, no, it’s understandable. And I would call the audience in terms of us in the medical community have taken great steps to make sure that we have all the safety measures in place, the social distancing, the mask requirements. Our clinics also have telemedicine opportunities. So, you know, at Hopkins and other places, one can have a telemedicine appointment. So but your point is well taken. And the question is, I’m at home, what can I look for? Unfortunately, I would say that most cancers that we detect today, would detecting without symptoms, but some of the symptoms that one can look at are a weak stream, pain on urination, pain on ejaculation, blood in the ejaculate. Those would be symptoms that are potentially prostate cancer but I would also tell the audience that they’re very non specific. There are so many other things that can cause the same exact symptoms. So it’s not uncommon for men to come to us and say, my stream is weak, all of a sudden, I’m 60 years old, I think I have prostate cancer. The most common is going to be enlargement of the prostate because that’s what happens. But those would be the symptoms, if you’re bothered by them. If they’re new, at least get them checked out to make sure that it’s not prostate cancer. But I would reassure most men who have the symptoms do not have prostate cancer. Bone pain is another one, especially the hips and in the pelvis but back pain is so common today from just musculoskeletal discs and things like that. So again, I wouldn’t panic about that. But if there’s a strong family history in your family of prostate cancer, those are things to be aware of. And ultimately, it’s a discussion between you and your healthcare provider.”
Kelsey Nicole Nelson – 13:12
“And I appreciate you touching that.. Just off that, I just want to make sure that they understand out there. So it’s nothing that you can do in your normal healthy life, right? It’s not foods that you eat or exercise that you’re doing. I’m sure that can help but specifically, right, nothing’s been tied to preventing prostate cancer.”
Dr. Mohamad Allaf – 13:27
“Yeah, I mean, I think if you look at some epidemiological studies, looking at associations, right, certainly the things that you would say are bad; animal fats, things like that eating, you know, steak every night, and that sort of thing is been shown to be negative. So having a vegetable filled sort of diet filled of antioxidants and I tell my patients, honestly, it’s everything in moderation from a diet standpoint. We know that obesity and tobacco use while they’re not linked like it would be for lung cancer. There’s a signal there in the literature. Exercising, eating a healthy diet and not using tobacco are going to be good things for your health in general and may help change your risk of prostate cancer.”
Kelsey Nicole Nelson – 14:21
“That is great. Now, obviously, we want people to make sure that they’re looking out but the main thing is, go to your doctors, make sure you’re getting healthy and regularly and early detection seems to be key. And then to wrap along, I want to make sure people understand the treatment options. Let me go back over those one more time. You know, if somebody is diagnosed with prostate cancer, what are some treatment options? And also, you know, are they able to easily access your facility if they like to?”
Dr. Mohamad Allaf – 14:51
“So I’m very lucky because I work at Johns Hopkins where we were the first department of Urology in the country. Neurology started at Johns Hopkins in 1904 and then a big discovery in the mid 1980s. The discovery of the nerve bundles that are responsible for erections, and prior to that discovery, most men who had surgery bled a lot, were incontinent of urine when you’re losing urine and had erectile dysfunction. And since those that discovery and all the technological know-how that we’ve had, I think those those types of issues are now much rarer than they ever were. Let’s go back and say, we’ve been diagnosed with prostate cancer, what are the options here? It’s an early localized cancer, then sometimes no treatment at all is necessary. So we know that some prostate cancers are tigers, and others are pussycats and if we get diagnosed by something that looks like cancer. But it’s not meant to hurt us during this lifetime. Because remember, it is much more common in older men to have prostate cancer, but not all prostate cancer is going to be lethal. If we identify it early, we now have ways to watch it; getting an MRI each year, maybe we repeat the biopsy every two years. We have a very robust what we call active surveillance program at Hopkins that maintains a patient’s quality of life while keeping an eye on this early cancer. If it ever progresses to a point where it needs treatment, we then bring out the hammer and hit it with it. Now, what are the hammer. In general, the two time tested approaches to dealing with early prostate cancer will be radiation therapy and it comes in many different forms. There’s the external beam, the seeds, there’s multi-week treatments, there are condensed five day treatments. So it just depends on your situation, the size of your prostate, your symptoms, we would pick the best option there if that’s where we want to go. And of course, surgery remains a very good definitive gold standard way of doing it. And now, we do surgery using a robotic tool. It’s called a robotic prostatectomy where we could do it using smaller incisions than ever before. You’re in the hospital typically for one night, and then you recover for a little bit of time and hopefully go along and lead a normal life after that.”
Kelsey Nicole Nelson – 17:25
“Nice. That’s what people want to be able to lead a healthy life. I think that’s important to know and I appreciate you touching on all the topics. I appreciate your time so much. Before I let you go the last words for the listening audience.”
Dr. Mohamad Allaf – 17:39
“I’m a big believer in going to a doctor that you believe in and that’s someone who’s going to be open with communication. I would tell the audience, sometimes as men, we put our heads in the sand and we would rather not know them to know because you’ve heard all these stories. I would just tell everybody to empower yourself with information and knowledge and see a good urologist or a good physician who’s going to counsel you well. Ultimately, look at your family and your kids and all of that and I know that they want you to be in the best of health and to live as long as possible. Being healthy and early detection is the best way to do it. So get checked, get informed. Kelsey, it’s been a pleasure to be with you today. Thank you so much for having me.”
Kelsey Nicole Nelson – 18:34
“Thanks so much for joining me and thank you for your message. It’s so important of course, we’re talking about in September but the conversation should never stop you guys. Mohamad Allaf from Johns Hopkins Medicine. Wanna show love to Baltimore since this show is based in the DMV. Thank you so much for your time, and love the little line. I hope you enjoy fatherhood. Thanks so much again for coming on the show.”
Dr. Mohamad Allaf – 18:56
“I’m not excited about the diaper changes, but thank you Kelsey.”
